1755. Influenza Antiviral Use among High-Risk Outpatients during Four Recent Influenza Seasons — United States, 2011–2015
Session: Oral Abstract Session: Prevalence and Outcome of Respiratory Tract Infections
Saturday, October 29, 2016: 9:30 AM
Room: 275-277

Background: Influenza is a contagious respiratory illness that results in 115,000–630,000 hospitalizations in the US annually. Early antiviral treatment can reduce the risk of complications, including hospitalization and death, and is recommended by CDC for all outpatients at increased risk of influenza-associated complications due to age or comorbidities. However, previous studies suggest that antiviral prescribing is low. We examined four recent influenza seasons to assess the frequency of influenza antiviral prescriptions among high-risk outpatients and to determine which characteristics predict receipt of an antiviral medication.

Methods: We analyzed antiviral prescription data for outpatients aged ≥6 months who presented with respiratory illness of ≤7 days duration and were enrolled in the US Influenza Vaccine Effectiveness Network in five states during the 2011–12 to 2014–15 influenza seasons. We obtained clinical information from interviews and medical record extraction. All patients had respiratory specimens that were tested for influenza by RT-PCR. We used multivariable logistic regression to identify predictors of antiviral prescribing. Early presentation was defined as presenting to care within 2 days of symptom onset. 

Results: During four seasons, 898 (7%) of 12,194 high-risk outpatients were prescribed antiviral medications, including 4% of those aged ≤2 years, 9% aged ≥65 years, 8% with ≥1 underlying medical condition, and 16% of pregnant women. Among 3,794 high-risk outpatients who presented early, 593 (16%) were prescribed antivirals. Of those, 1,083 had PCR-confirmed influenza infection and 399 (37%) were prescribed antiviral treatment. Early presentation to care was significantly associated with receipt of an antiviral prescription (OR=8.26, CI: 6.4–10.7), as was testing positive for influenza (OR=4.79, CI: 4.1–5.6) and the presence of an underlying medical condition (OR=1.32, CI: 1.1–1.7) among other factors.

Conclusion: In this multi-state study, influenza antiviral medications were consistently under-prescribed for high-risk outpatients. Further efforts are needed to better understand barriers to antiviral prescribing and to improve use in order to reduce influenza-associated complications.




Rebekah Stewart Schicker, MSN, MPH, NP-C1, Brendan Flannery, PhD2, Jessie Chung, MPH3, Manjusha Gaglani, MBBS4, Richard K. Zimmerman, MD MPH, FIDSA5, Lisa A. Jackson, MD, MPH, FIDSA6, Joshua G. Petrie, PhD7, Huong Q. Mclean, PhD, MPH8, Mary Patricia Nowalk, PhD5, Michael L. Jackson, PhD, MPH9, Arnold S. Monto, MD, FIDSA7, Edward Belongia, MD8, Heather Eng, BS10, Shikha Garg, MD, MPH1, Alicia M. Fry, MD, MPH2 and Fiona Havers, MD, MHS2, (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, (3)Atlanta Research and Education Foundation, Inc, Atlanta, GA, (4)Baylor Scott & White Health, Texas A&M HSC COM, Temple, TX, (5)Family Medicine, University of Pittsburgh, Pittsburgh, PA, (6)Center for Health Studies, Seattle, WA, (7)Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, (8)Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, Marshfield, WI, (9)Group Health Research Institute, Seattle, WA, (10)University of Pittsburgh, Pittsburgh, PA


R. S. Schicker, None

B. Flannery, None

J. Chung, None

M. Gaglani, CDC: Investigator , Grant recipient
MedImmune/AstraZeneca: Investigator , Grant recipient
Novartis: Investigator , Grant recipient

R. K. Zimmerman, Sanofi Pasteur: Investigator , Grant recipient
Pfizer: Investigator , Grant recipient
Merck: Investigator , Grant recipient

L. A. Jackson, Inviragen: Investigator , Research support
Pfizer: Investigator , Research support and travel support
Novartis: Investigator , Research support
Sanofi: Investigator , Research support

J. G. Petrie, CDC: Investigator , Grant recipient

H. Q. Mclean, Novavax Inc.: Investigator , Research support
Medimmune, LLC.: Investigator , Research support
CDC: Investigator , Research support

M. P. Nowalk, None

M. L. Jackson, None

A. S. Monto, Sanofi Pasteur: Consultant and Grant Investigator , Consulting fee and Grant recipient
GSK: Consultant , Consulting fee
Novavax: Consultant , Consulting fee
Novartis: Consultant , Consulting fee
CDC: Investigator , Research support
Roche: Consultant , Consulting fee
Biocryst: Consultant , Consulting fee

E. Belongia, MedImmune: Investigator , Research support
Novavax: Investigator , Research support
CDC: Investigator , Research support

H. Eng, None

S. Garg, None

A. M. Fry, None

F. Havers, None

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